Thirty years after the launch of Women's Health Issues, it is without question that great progress has been made towards the health and well-being of women. In his introduction to the first issue of Women's Health Issues, founding editor Warren H. Pearse noted that a combination of advances in medical science and changes in expectations about reproduction and work were reshaping women's health care and their lives (). Three decades later, medical science and social forces continue to influence women's opportunities to live healthy lives and exercise autonomy. Women's Health Issues has published more than 1500 research and policy studies to ensure an evolving, socio-ecological, and thoughtful narrative around key women's health challenges and disparities, including reproductive health, maternal mortality, chronic disease, cancer, mental health, and gender-based violence.
Women's Health Issues was founded during the surge of women's health advocacy and research in the United States that resulted in an expanded agenda for interdisciplinary women's health research, unprecedented US policy initiatives in women's health, and a growing awareness that women's health as a field covers more than reproductive issues and more than clinical care. The journal itself grew and expanded its content and reach along with these trends. Today the journal continues to move the field forward by publishing rigorous research and commentaries addressing key issues that contribute to the health and well-being of all women. In commentaries and research articles, Women's Health Issues authors have covered a wide array of topics and many different populations. The lists of honorees for our annual Charles E. Gibbs Leadership Prize (https://www.whijournal.com/content/Charles_E_Gibbs_Prize) and Editor's Choice (https://www.whijournal.com/content/whi-free-collection) showcase the wide range of topics our authors cover, as well as their skill at conveying why their research findings matter for women's health.
As we look back over the last 30 years, the scientific, policy, and practice community must take a moment to applaud and celebrate many milestones in women's health and health care. We have witnessed significant advances, including the 2006 introduction of an HPV vaccine in the US, leading to a 56% decline in cervical precancer among those aged 18–20 and a 39% decline among those aged 21–24 (
Gargano et al., 2019
). Thirty years ago medication abortion was an aspiration; in 2000 the FDA approved Mifeprex, and now over one-third of abortions at 8 weeks' gestation or earlier are medication abortions (KFF, 2020
). Plan B emergency contraception was approved by the FDA in 1999; after years of high-quality science and advocacy, the FDA announced its decision to make Plan B available over-the-counter for women ages 18 and over in 2006, and then in 2013 that the Plan B pill would be made available for girls ages 15 and older without a prescription (KFF
The Availability and Use of Medication Abortion.
The Availability and Use of Medication Abortion.
https://www.kff.org/womens-health-policy/fact-sheet/the-availability-and-use-of-medication-abortion/
Date: 2020
Date accessed: November 20, 2020
Office of Population Research, 2020
). In 2008, the Turnaway Study, a prospective longitudinal study examining the effects of unintended pregnancy on women's lives, changed the narrative of unintended pregnancies and abortion by filling critical gaps in what we know about the short- and long-term consequences of being denied a wanted abortion (Advancing New Standards in Reproductive Health, 2020
).An important shift in women's health over the last three decades included uncovering an important truth: a woman's health involves more than just her reproductive capacity. The field expanded its definition and perspective of women's health in 1991 (shortly after the debut of Women's Health Issues) when one of the largest prevention studies, the Women's Health Initiative, launched with a $625 million grant from the National Heart, Lung, and Blood Institute (
Women's Health Initiative, 2020
). This landmark study continues today and has resulted in more than 1800 publications on aspects of U.S. women's health ranging from cancer to chronic disease. And more recently, our expanded research landscape around women's health has led to a new commitment towards recognizing, examining, and understanding sex and gender differences across all health behaviors and outcomes. A growing body of work demonstrates sex and gender differences in diagnosis, treatment, and health outcomes. The year Women's Health Issues launched, the Office of Research on Women's Health was established at the National Institutes of Health (NIH) (Office of Research on Women's Health,
), and the Congressionally mandated Food and Drug Administration (FDA) Office on Women's Health debuted in 1994 (Office of Research on Women's Health
Mission and History.
Mission and History.
https://orwh.od.nih.gov/about/mission-history
Date accessed: November 20, 2020
U.S. Food and Drug Administration, 2019
). Both offices have played important roles in ensuring that research is more inclusive. For instance, the FDA revised its regulations for new drug applications in 1998 to require that manufacturers present effectiveness data by gender, age, and racial subgroups (U.S. Food and Drug Administration
Office of Women's Health.
Office of Women's Health.
https://www.fda.gov/about-fda/office-commissioner/office-womens-health
Date: 2019
Date accessed: November 20, 2020
Investigational New Drug Applications and New Drug Applications, 1998
), and in 2014 updated requirements for what prescription drug information must disclose about potential effects for those who are pregnant or breastfeeding (Investigational New Drug Applications and New Drug Applications
https://www.govinfo.gov/content/pkg/FR-1998-02-11/pdf/98-3422.pdf
Date: 1998
Date accessed: November 20, 2020
Content and Format of Labeling for Human Prescription Drug and Biological Products; Requirements for Pregnancy and Lactation Labeling, 2014
). In 1994, the NIH issued its first guidelines on the inclusion of women and members of minoritized groups in clinical research (Content and Format of Labeling for Human Prescription Drug and Biological Products; Requirements for Pregnancy and Lactation Labeling.
https://www.govinfo.gov/content/pkg/FR-2014-12-04/pdf/2014-28241.pdf
Date: 2014
Date accessed: November 20, 2020
National Institutes of Health, 1994
), and updated them in 2001 (National Institutes of Health, 2001
) and 2017; the 21st Century Cures Act, signed into law in 2016, requires trials to report their results disaggregated by sex/gender and race/ethnicity in ClinicalTrials.gov (National Institutes of Health
NIH Policy on Reporting Race and Ethnicity Data: Subjects in Clinical Research.
NIH Policy on Reporting Race and Ethnicity Data: Subjects in Clinical Research.
https://grants.nih.gov/grants/guide/notice-files/NOT-OD-01-053.html
Date: 2001
Date accessed: November 20, 2020
National Institutes of Health, 2017
).National Institutes of Health
Amendment: NIH Policy and Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research.
Amendment: NIH Policy and Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research.
https://grants.nih.gov/grants/guide/notice-files/NOT-OD-18-014.html
Date: 2017
Date accessed: November 20, 2020
The last three decades have been marked by significant changes in women's roles in the labor force, sparking research on how these changes affect the health and well-being of women. For example, as women have accounted for a growing share of the US veteran population, the Veterans Administration (VA) has supported a growing body of research into women veterans' health. Milestones include development of the first national VA Women's Health Research Agenda in 2004 (
Yano et al., 2006
) and the creation of the VA Women's Health Research Consortium in 2010 (- Yano E.M.
- Bastian L.A.
- Frayne S.M.
- Howell A.L.
- Lipson L.R.
- McGlynn G.
- Schnurr P.P.
- Seaver M.R.
- Spungen A.M.
- Fihn S.D.
Toward a VA Women's Health Research Agenda: setting evidence-based priorities to improve the health and health care of women veterans.
Journal of General Internal Medicine. 2006; 21: S93-S101
Yano and Frayne, 2011
).Many policies at the state and federal levels, and across multiple branches of government, have advanced women's health in the US, but none more so than the Affordable Care Act (ACA). The ACA, formally known as the Patient Protection and Affordable Care Act, was enacted by the 111th Congress and signed into law by President Barack Obama on March 23, 2010, and has advanced women's health by increasing access to health insurance and health care nationwide. The ACA expanded Medicaid, prohibited insurers from charging different premiums based on gender, and eliminated exclusions for pre-existing conditions. Further, the ACA improved women's health by requiring no-cost coverage of preventive services such as mammograms, well visits, contraception, and breastfeeding support.
History will remember the last 30 years as a time of great progress for women. However, many old challenges remain, and new ones have emerged. The U.S. pregnancy-related deaths rate is far higher than that of other industrialized countries, and Black, American Indian, and Alaska Native women are 2–3 times more likely to die from pregnancy-related causes than White women (
Petersen et al., 2019
). Although better access to highly effective contraceptive methods has helped many people exercise reproductive autonomy, almost half of all pregnancies in the United States are unintended (Finer and Zolna, 2016
) (though, as a growing body of research indicates, not intending to be pregnant is not synonymous with being unhappy about pregnancy). One in four women has been a victim of intimate partner violence in her lifetime, and more than 80% of these women report significant short- or long-term health impacts from this violence (Campbell, 2002
). Women are three times more likely to die following a heart attack compared to men (Alabas et al., 2017
) and more than 1 in 5 women in the United States experienced a mental health condition such as depression or anxiety in the last year (- Alabas O.A.
- Gale C.P.
- Hall M.
- Rutherford M.J.
- Szummer K.
- Lawesson S.S.
- Jernberg T.
Sex Differences in Treatments, Relative Survival, and Excess Mortality Following Acute Myocardial Infarction: National Cohort Study Using the SWEDEHEART Registry.
Journal of the American Heart Association. 2017; 6: e007123
Riecher-Rössler, 2017
).In 2020, the COVID-19 pandemic is exacerbating existing gender inequities. Women—especially Black and Latinx women—are disproportionately likely to work low-wage service jobs and are facing layoffs and reduced hours with already limited financial cushions. In ordinary times, US women spend 37 percent more time on unpaid care than men (
U.S. Department of Labor, 2019
); now, with children home from school and new challenges for older adults who need assistance, women are struggling under competing demands and disproportionately likely to leave paid jobs because of caregiving responsibilities. In the United States, 75% of all healthcare jobs are held by women (U.S. Census Bureau, 2020
). They are our physicians, nurses, midwives, and community health workers, and are facing an elevated risk of COVID exposure while performing essential work for their communities.U.S. Census Bureau
Full-Time, Year-Round Workers and Median Earnings: 2000 and 2013-2018.
Full-Time, Year-Round Workers and Median Earnings: 2000 and 2013-2018.
https://www.census.gov/data/tables/time-series/demo/industry-occupation/median-earnings.html
Date: 2020
Date accessed: November 23, 2020
The year 2020 is also the year we lost one of our greatest women's health advocates, Justice Ruth Bader Ginsberg. She was a powerful voice on the Supreme Court of the United States and her court opinions replaced long-existing stereotypes about women's physical and mental vulnerabilities with an evidence-based understanding of women's lives. Her pivotal work emphasized laws' impacts on women's health and the ways in which women's health is tied to their economic opportunities and ability to achieve equity. Without her presence on the Court, we face an uncertain outcome in pending cases addressing reproductive rights and the future of the ACA.
Although the health of women in the US has improved since the launch of Women's Health Issues, not all women have benefited equally. Inequities by race, ethnicity, immigration status, age, disability, geographic location, sexual orientation, and gender identity reflect both structural inequities and the bias and discrimination that individuals encounter as they seek health care and go about their lives. In the field of women's health, we must acknowledge both the intersecting forms of oppression that shape the experiences of women with multiple marginalized identities and the fact that cisgender women are not the only ones who need “women's health” care and research. The Affordable Care Act has brought greater access to health care to many underserved individuals, including women, but achieving health equity will require overhauling policies, institutional practices, and individual behaviors—all while following the leadership of those who experience the harms of inequities and know how to achieve just outcomes (
Barlow and Johnson,
).- Barlow J.N.
- Johnson B.M.
Listen to Black Women: Do Black Feminist and Womanist Health Policy Analyses.
Women's Health Issues. 2020; (Epub ahead print)https://doi.org/10.1016/j.whi.2020.11.001
Over the next 30 years, researchers will develop new interventions, advocates will shape public opinion and policies, public officials will adopt laws and regulations, and courts will uphold them or strike them down. As women determine the course of their lives, myriad forces will shape their opportunities to achieve health and autonomy. Women's Health Issues will remain committed to publishing and disseminating research on the effects and opportunities of changes in medical care, policies, and social forces, and prioritize publications that advance equity. Our ability to publish high-quality research relevant to women's lives depends upon contributions from a long list of collaborators. Our authors, peer reviewers, editorial board members, publishing colleagues, staff, and readers all play essential roles in our success, and we offer all of you our sincere thanks. We close as Warren Pearse did in this journal's first issue: “To you all, good reading, good writing, and clear thinking.”
References
- The Turnaway Study.(Available:)
- Sex Differences in Treatments, Relative Survival, and Excess Mortality Following Acute Myocardial Infarction: National Cohort Study Using the SWEDEHEART Registry.Journal of the American Heart Association. 2017; 6: e007123
- Listen to Black Women: Do Black Feminist and Womanist Health Policy Analyses.Women's Health Issues. 2020; (Epub ahead print)https://doi.org/10.1016/j.whi.2020.11.001
- Health consequences of intimate partner violence.Lancet. 2002; 359: 1331-1336
- Content and Format of Labeling for Human Prescription Drug and Biological Products; Requirements for Pregnancy and Lactation Labeling.(21 CFR Part 201. Available:)https://www.govinfo.gov/content/pkg/FR-2014-12-04/pdf/2014-28241.pdfDate: 2014Date accessed: November 20, 2020
- Declines in unintended pregnancy in the United States, 2008–2011.New England Journal of Medicine. 2016; 374: 843-852
- Trends in High-grade Cervical Lesions and Cervical Cancer Screening in 5 States, 2008-2015.Clinical Infectious Diseases. 2019; 68: 1282-1291
- (21 CFR Parts 312 and 314. Available:)https://www.govinfo.gov/content/pkg/FR-1998-02-11/pdf/98-3422.pdfDate: 1998Date accessed: November 20, 2020
- The Availability and Use of Medication Abortion.(Available:)https://www.kff.org/womens-health-policy/fact-sheet/the-availability-and-use-of-medication-abortion/Date: 2020Date accessed: November 20, 2020
- NIH Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research.(Available:)
- NIH Policy on Reporting Race and Ethnicity Data: Subjects in Clinical Research.(Available:)https://grants.nih.gov/grants/guide/notice-files/NOT-OD-01-053.htmlDate: 2001Date accessed: November 20, 2020
- Amendment: NIH Policy and Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research.(Available:)https://grants.nih.gov/grants/guide/notice-files/NOT-OD-18-014.htmlDate: 2017Date accessed: November 20, 2020
- History of Plan B OTC.(Available:)
- Mission and History.(Available:)https://orwh.od.nih.gov/about/mission-historyDate accessed: November 20, 2020
- Apologia.Women's Health Issues. 1990; 1: 1
- Racial/Ethnic Disparities in Pregnancy-Related Deaths-United States, 2007-2016.MMWR Morbidity and Mortality Weekly Report. 2019; 68: 762-765
- Sex and gender differences in mental disorders.Lancet Psychiatry. 2017; 4: 8-9
- Full-Time, Year-Round Workers and Median Earnings: 2000 and 2013-2018.(Available:)https://www.census.gov/data/tables/time-series/demo/industry-occupation/median-earnings.htmlDate: 2020Date accessed: November 23, 2020
- American Time Use Survey – 2018 Results.2019
- Office of Women's Health.(Available:)https://www.fda.gov/about-fda/office-commissioner/office-womens-healthDate: 2019Date accessed: November 20, 2020
- Women's Health Initiative: Changing the Future of Women's Health.(Available:)
- Toward a VA Women's Health Research Agenda: setting evidence-based priorities to improve the health and health care of women veterans.Journal of General Internal Medicine. 2006; 21: S93-S101
- Health and Health Care of Women Veterans and Women in the Military: Research Informing Evidence-Based Practice and Policy.Women's Health Issues. 2011; 21: S64-S66
Article info
Publication history
Published online: December 09, 2020
Identification
Copyright
© 2020 Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health.
